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Wednesday, 27 November 2013

Restrictive lung diseases (Respiratory Disease) – The Diagnosis

Respiratory Disease is defined as medical conditions, affected the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and  muscles breathing , etc,.
Restrictive lung diseases or restrictive ventilatory defects
Restrictive lung disease is a condition marked most obviously by a reduction in total lung capacity. A restrictive ventilatory defect may be caused by a pulmonary deficit, such as pulmonary fibrosis (abnormally stiff, non-compliant lungs), or by non-pulmonary deficits, including respiratory muscle weakness, paralysis, and deformity or rigidity of the chest wall(1).
D. Diagnosis 
If you are experience some of the above symptoms and if your doctor suspects that you have restrictive lung function, after recording your family history and completing the physical exam, the test which your doctor orders include
1. Chest CT scan and echocardiography
In the study to examine the frequency and spectrum of diseases associated with isolated reduction in the diffusing capacity of lung for carbon monoxide (D(Lco)) of the 38,095 patients who underwent PFTs during the study period, 179 (0.47%; 95% confidence interval [CI], 0.40%-0.54%) had isolated D(Lco) abnormalities. The 27 patients (15.1%; 95% CI, 10.2%-21.2%) who had also undergone chest CT and echocardiography within 1 month of PFTs form the study cohort reported herein. Their mean D(Lco) was 50% +/- 15% (95% CI, 45%-56%) with average normal pulse oxygen saturation at rest and mild hypoxemia with activity. Thirteen of the 27 patients (48%; 95% CI, 28.7%-68.1%) had underlying emphysema evident on CT. Eleven of these 13 patients had emphysema associated with a restrictive lung process. The 14 patients without emphysema had interstitial lung disease, pulmonary vascular disease, and other isolated findings(18).
2. Utility of cardiopulmonary exercise testing
Restrictive lung disease occurs commonly in patients with neuromuscular disease.Exercise testing is mandatory because pulmonary function tests at rest are not reliable for the diagnostic evaluation and functional characterisation of these patients. Cardiopulmonary exercise testing (CPET) with measurement of gas exchange is the favoured tool. It is an excellent method to investigate exercise dyspnea, describe altered physiological response to exercise and characterise the involved organ systems heart, lung and muscle(19).
3. FEV1/FVC ratio test
The aim of the test is to analyze the  forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). In patients with restrictive lung disease, ratio is higher than 80% as the decline in FVC is more than that of FEV1. In the study use of clinical and spirometry findings in order to distinguish between the restrictive and nonspecific patterns of pulmonary function test results in patients with low FVC and a normal or elevated FEV1/FVC ratio, showed that the most common causes of a nonspecific pattern were obstructive disorders, congestive heart failure, obesity, bronchiolitis, interstitial diseases, and neuromuscular disorders. In patients given a working diagnosis of pulmonary fibrosis, pleural disease, or chest wall disease, the positive predictive value (PPV) for restriction was >or= 90%. In males, an FVC <or= 60% of predicted had a PPV for restriction of 98.8%. In females, the restrictive pattern was found in 84.4% of those with an FVC <or= 50% of predicted. A difference of >or= 0% between the FEV1% and the FVC% had a PPV for restriction of 89.5%. After performing logistic regression, we developed a point scale for predicting the restrictive pattern(20).
4. Spirometry
Spirometry measures the flow and volume of air entering and leaving the lungs. It is used to assess ventilatory function and differentiates between normality and diseases causing obstructive and possibly restrictive defects(21).
4. Etc.
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Sources
(1) http://oac.med.jhmi.edu/res_phys/Encyclopedia/RestrictVentDefect/RestrictVentDefect.HTML
(18) http://www.ncbi.nlm.nih.gov/pubmed/17285785
(19) http://www.ncbi.nlm.nih.gov/pubmed/19924618
(20) http://www.ncbi.nlm.nih.gov/pubmed/20835593
(21) http://www.ncbi.nlm.nih.gov/pubmed/21597532